Vaccinations and IBD

Appropriate vaccines are one of the ways you can keep yourself healthy, especially when you are using IBD medicines. It is important that you complete vaccinations soon after diagnosis of having Crohn's disease or ulcerative colitis. It is also very important to be aware that some vaccines are LIVE VACCINES and should be avoided when using immune-suppressing medicines.

Vaccination plan

Childhood: MMR, polio, rotavirus, Hib, TdaP, chickenpox, and hepatitis A and B long before immune suppressed

At diagnosis of IBD: If immunosuppressive medicine is not needed right away, consider pneumonia vaccine, shingles vaccine, and flu shot.

Details about vaccines

The pneumonia vaccine (Pneumovax®) can protect people against 23 of the most aggressive types of pneumonia with just one shot. It is not a live vaccine and will not give you pneumonia. This vaccine is advised for all adults age 65 and older and also for anyone who is taking immunosuppressive medicines (including prednisone). A booster is given at 5 years.

The flu vaccine can prevent the flu or shorten the time the flu lasts and ease its symptoms. A flu shot is advised each fall for anyone who takes immunosuppressive drugs. YOU SHOULD NOT USE THE LIVE FLU VACCINE. If you have inflammatory bowel disease you receive priority for influenza vaccines, should they be in short supply.

The hepatitis B vaccine is given to prevent severe infections of the liver. These infections can be more serious, and even fatal, among people who are taking anti-TNF medicines. This vaccine is now a part of the routine childhood shots. It is a good idea for everyone with IBD to get it because an anti-TNF medicine may be needed in the future. You need three (3) shots over 6 months for the vaccine to work. It often comes in a form that combines both hepatitis A and hepatitis B vaccines in a single shot (although it is still three [3] shots total).

The human papilloma virus (HPV) vaccine (Gardasil®) is recommended for young women between ages 11 and 26 to reduce their risk for cervical cancer. It is a good idea for young women with IBD to have this vaccine because they may need an immunosuppressive medicine in the future. A total of three (3) shots are required.

Chickenpox and shingles are caused by the same virus – varicella zoster. This virus lives on in the body after chickenpox and can occur again as shingles. Having the vaccine for both chickenpox and shingles is advised for adults. However, because these are made of the live virus, they are not safe for someone who is taking immunosuppressive medicines, such as prednisone, Imuran®, methotrexate, Remicade®, Humira®, or Cimzia®. It is best to have one of these vaccines at least 2 months after stopping an immunosuppressive medicine, and to not start taking immunosuppressive medicine for about 2 months after having one of these shots.

Injectable polio vaccine is not an active virus, and will not cause polio. This vaccine is advised for children. The oral form is a live vaccine and is not considered safe for people who take immunosuppressive medicines.

Problems with LIVE VACCINES (planning ahead)

Many vaccines work better if they are alive but weak. They cause a better immune response. However, if you are taking an immunosuppressive medicine, these vaccines can cause infections. It is VERY IMPORTANT to avoid active virus vaccines while taking immunosuppressive medicines. The five vaccines that only come in live forms should be given at least 2 months before starting to take an immunosuppressive medicine (for example, prednisone, azathioprine, methotrexate, Remicade®, Humira®, Cimzia®). Live vaccines should not be given while you are taking immunosuppressive drugs, or within 2 months after these drugs are stopped. The inactivated form should be used instead whenever possible.

Common live vaccines

Nasal spray (Intranasal) flu shot – the flu vaccine given as a shot not live

Varicella (chickenpox and shingles)

MMR (measles, mumps and rubella) – this vaccine is used in children only and as booster for healthcare workers who have negative titer

Rotavirus – this vaccine is used in children only

Oral polio – this vaccine is used in children only;
the injectable polio vaccine, which is not live, is also good for children

Uncommon live vaccines

Smallpox

Yellow fever

Oral typhoid – can use injectable typhoid

Special vaccine situations (international travel and military)

In special situations, you may consider having these other vaccines:

Situation

Vaccine

Veterinarians, animal handlers, cave explorers, or after an animal bite

Rabies

Anthrax laboratory workers, military personnel

Anthrax

Children (adults should have a Td booster shot every 10 years or deep wound. At least one of these booster shots needs to be Tdap).

Tdap (tetanus/diphtheria/pertussis)

Travel in Central or South America, Mexico, Asia (except Japan), Africa, and Eastern Europe; men who have sex with men; people who use street drugs; people with chronic liver disease; people treated with clotting factor concentrates; hepatitis A lab workers; also part of routine childhood shots

Hepatitis A

Children younger than 5 years; people without a spleen; people with sickle cell disease or HIV

Hib (Haemophilus influenzae type B)

Travel in rural Japan

Japanese encephalitis virus*

Anyone born after 1956

MMR* (measles/mumps/rubella)

College freshmen, military recruits, children, travelers to Africa, people with a damaged spleen